It was the month of July and I was very excited to go to Puri and see Lord Jagannath’s Rathyatra. I asked my mother and aunt to come along with me. But aunty refused. She said that she had been to Rathyatra many years ago. After seeing the huge crowd there, she was very frightened. She had felt as if she was trapped and squeezed. She also felt as if someone had tied her with a tight rope and she was unable to breathe. Since then, she gets panicked whenever she faces a crowd. She remembers that day and gets the same feeling all over again. On hearing this, I said- “Aunty, this is baseless fear. This is called Phobia and can be treated.” My mother was curious to know more about it. I said- “There are many types of Phobia. Different people have different types of Phobia. Some people are afraid of animals/ insects like cockroach, frog, dog, etc. and some others afraid to go near water, like pond, rivers etc. because of the fear of drowning or because they have seen someone drowning.
Aunty looked at my mother and said – “Gayatri, do you remember Ravi from our village ? I met him few days back. He is so well educated but never able to speak a word on dais or in front of a gathering. He simply panics. One day he was travelling by train and the train got derailed. From then onwards, he is so much frightened, he never travels by train. He doesn’t even travel by bus. In fact, he never goes alone anywhere thinking that there is no one to help and always calls a friend to accompany him. I said “This is also a type of phobia”. Aunty was now curious to know more about this disease.
I said “some patients are afraid of height, some afraid of darkness, some of small closed places like lift etc. There are many types of phobia. Every person is afraid of something or the other. But when this fear becomes so strong that it interferes in their day to day activities and social life, then we call it phobia. Such a person should consult a psychiatrist. Psychiatrists would help patients to identify their problems and cope with the feelings. With help of medications, patients can lead a symptom free productive life.”
1.What is the difference between fear and a phobia?
Fear is a normal psychological and physiological reaction to an actual threat or danger, or to the anticipation of an actual threat or danger. A phobia is an excessive and unreasonable degree of fear triggered either by exposure to or anticipation of a specific object or circumstance. People with specific phobias realize that their level of fear is excessive, but they still try to avoid any exposure to the feared object or circumstance. These avoidance attempts and the anxiety that results when avoidance is unsuccessful cause a significant disruption in normal functioning.
Animal type Insects Blood/injury type Injections/blood draws
Snakes Seeing blood
Dogs Seeing an injured person
Nature type Storms Situational type Driving
2.How do people develop phobias?
It is not clear why some people develop specific phobias. Many phobias begin in childhood—particularly those of the animal and nature type. Very often there has never been an exposure to the feared object or situation. In fact, if there has been a traumatic exposure (for instance, an attack by a dog), then future avoidance more accurately reflects the type of avoidance seen in post-traumatic syndromes. People with phobias tend to overestimate the degree of danger that a given situation or object represents. Again, if the level of fear is reasonable and appropriate, then the individual is not considered to have a phobia.
3.What is agoraphobia?
Agoraphobia is the fear of being in a place or situation from which escape would be difficult or embarrassing, or where it might be difficult to get help should panic symptoms arise. The anxiety caused by this fear is so great that such situations are avoided or tolerated only with extreme distress. Agoraphobia may occur in panic disorder or it may occur in the absence of panic. People with agoraphobia tend to limit their activities (e.g., not go to stores or, in extreme cases, not leave their homes) or they may pursue such activities only when accompanied by someone with whom they feel safe (such as a spouse).
4.How specific phobia is treated?
When the phobia is of a specific situation that can be anticipated, such as a fear of flying, the use of low-dose benzodiazepines prior to the experience also can be effective. The medication allows them to tolerate the exposure, but generally does not affect future exposures to the feared situation.
Cognitive behavioral therapy is very effective treatment for a specific phobia. Through a process of graded exposure called systematic desensitization, individuals with a phobia are able to extinguish or control their response.
5.What is social phobia?
Social phobia is a form of phobia in which an individual has an excessive and persistent fear of a given social situation where they might be exposed to the scrutiny of others. The exposure to, or anticipation of, the feared situation causes a marked anxiety response, and the individual either avoids those situations or endures them with significant discomfort. The person usually recognizes that the fear is excessive. Avoidance attempts and/or the anxiety disrupts social or occupational functioning. The most well-known specific social phobia is
“performance anxiety”—the fear of public speaking. The most common fears seen in social phobia include speaking before a group or being the center of attention, eating in public, writing in public, and using public lavatories.
6.How common a problem is social phobia?
Social phobia is now known to be one of the most common psychiatric disorders in the general population. Epidemiologic researchers have found that there is a 13.3% lifetime prevalence of social phobia, with a higher prevalence existing in women (15.5%) than in men (11.1%).
7.What is the psychology behind social phobia?
People with social phobia tend to overestimate their own symptoms of anxiety—for instance, if they are feeling anxious and flushed, they may assume that they are beet red. They also misinterpret the responses of others in negative ways. They overestimate the degree to which other people are paying attention to them, and the likelihood that they will be embarrassed or rejected. Finally, they tend to overemphasize any perceived or actual failures, while discounting their achievements and positive feedback.
8.Can medications help in social phobia?
Absolutely. For individuals with specific social phobia, such as performance anxiety, ß -blockers (e.g., propranolol) can be beneficial.
Benzodiazepines (e.g., alprazolam, lorazepam,clonazepam) also are effective in these individuals and can be used on an as-needed basis. For those people with generalized social phobia, serotonin specific reuptake inhibitors (e.g., paroxetine, sertraline, fluoxetine) can be effective treatments.
9.Are there other types of treatment for social phobia?
An important form of treatment for social phobia is cognitive behavioral therapy (CBT). This type of therapy involves cognitive restructuring by helping the individual with social phobia identify his or her cognitive distortions and challenge the accuracy of their perceptions. They also learn how to decrease their physiologic response of anxiety with various techniques including deep-breathing and progressive muscle relaxation. Graded exposure to the feared situation also is employed as they learn to tolerate increasingly greater exposure to the feared situation. Eventually, the anxious response is extinguished. Group CBT also is helpful in the treatment of social phobia. This form of treatment includes social skills training and role-playing, and allows individuals to get direct, immediate feedback on their perceptions of how others view them.